Patient Forms

At Digestive Specialists, your time is as valuable to us as it is to you. When you arrive for your first office visit, a member of our staff will provide you with the required forms to fill out. There may be additional forms if you schedule a procedure. If you happen to misplace any of the provided forms, duplicates are available below.

Please visit our Prep Instructions page for specific instructions for your procedure.

Medical Records Release – Office Visits

Please print, complete, and sign this form if you need your medical records from Digestive Specialists, Inc.

Medical Records Release – Procedures

Please print, complete, and sign this form if you need your medical records from Digestive Endoscopy Center, LLC.

Notice of Nondiscrimination

Digestive Endoscopy Center, LLC does not discriminate or exclude on the basis of race, color, national origin, age, disability, or sex. Language services are available upon request.

gPortal Getting Started Card

Quick Reference Guide for Using gPortal

Billing Information Form

Understanding medical billing can be complicated. Our FAQs were created to help alleviate the confusion.

DSI Notice of Privacy Practices

Privacy Notice for office visits.

DECL Notice of Privacy Practices

Privacy Notice for procedures.

Patient Rights and Notification Brochure

This document describes your rights as a patient.

Referring Physician Form

1-Step GI Referral